Small effect of disease, treatment on Hodgkin’s lymphoma-related fatigue
medwireNews: Persistent fatigue, long after completion of treatment, is common in Hodgkin’s lymphoma survivors, and is largely unrelated to disease stage and treatment type, finds an analysis of three clinical trials conducted by the German Hodgkin Study Group.
In fact, multivariable analysis showed that only two factors – baseline fatigue and age as a continuous variable – significantly predicted fatigue at 2 and 5 years after the completion of treatment.
Therefore, the researchers recommend that “[f]atigue in patients with Hodgkin’s lymphoma should be assessed before treatment and possible origins of fatigue and comorbidities should be identified.”
“This approach might offer the opportunity for early interventions and prevent high, persistent, and detrimental fatigue in many survivors of Hodgkin’s lymphoma”, they write in The Lancet Oncology.
The analysis included 4215 patients enrolled in the HD13, HD14 and HD15 clinical trials that evaluated various first-line regimens in patients with early-stage favourable, early-stage unfavourable and advanced Hodgkin’s lymphoma, respectively. All participants reported on their fatigue levels, via the self-administered EORTC QLQ-C30 questionnaire, at one or more prespecified timepoints up to 5 years after completion of therapy.
At diagnosis, fatigue was associated with tumour burden, with an average score of 30.8 in patients with early-stage favourable disease, rising to 39.8 and 49.0 for those with early-stage unfavourable and advanced disease, respectively. These scores were an average 18.6, 28.8 and 37.2 points higher, respectively, than would normally be expected for age- and gender-matched members of the German general population.
Although fatigue levels at baseline varied in the three groups of patients in line with disease severity, levels during treatment and in the long-term were largely comparable.
Specifically, during treatment, fatigue scores rose to the same level across the three groups and were on average 47.4, 48.4 and 50.2 points above normal in the HD13, HD14 and HD15 trials, respectively.
And, as early as 1 year after completion, the average score for each of the three groups declined to the level achieved by patients with early-stage favourable disease in the HD13 trial (ie, 21.4), remaining stable thereafter up to 5 years post-treatment.
At these later stages, no clinical- or treatment-related parameters, other than baseline fatigue and age, were significantly associated with long-term fatigue.
Peter Borchmann (University Hospital of Cologne, Germany) and co-investigators say that the correlation between baseline and persistent fatigue could have a variety of underlying reasons.
“Cancer itself is a known cause of fatigue, which may translate to persistent fatigue of survivors”, they observe. “Additionally, sleep disturbances, low physical activity, anxiety, depression, and comorbidities can also be present at baseline and could contribute to persistent fatigue.”
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